Chemical Risk Assessment Form (COSHH) 2016 V3
Assessment completed by:
Is a current SDS available for
the product:
Product name/s:
Date:
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Physical appearance, form and odour:
Chemicals components:
Building and room/location of use:
Approximate quantity to be
used:
How often will the products be
used?
What is the nature of the
hazard?
List groups of people who could
be affected:
What will the product be used for?
Hazard Statements:
Physical Hazards H200-H290 &
EUH hazards:
Hazard Statements:
Health Hazards H300-H373 &
EUH hazards:
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How long will they be used for?
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Staff, Student, Visitor, Public, Contractor,
Other – please state
Possible route of entry into user:
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Fire and explosion risk? This will be identified Choose an item.
by the Hazard Statements H200 - H272 and
EUH Statements EUH001 – EUH044
Is medical surveillance required? This is
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needed if the product may cause asthma or
dermatitis as defined by the Hazard Statement
H317 or H334 (previously Risk Phrases R42 or
R43)
For all environmental hazards, include the details in the user information sheet.
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Hazard Statements
Environmental Hazards H400H420 & EUH hazards
Does the product have a
maximum exposure limit in air
(WEL) – quoted in EH40?
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How many people could be affected?
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WEL:
Is there a safer alternative product that could be used instead?
If you are not choosing the safer alternative – please state why:
State in minutes or hours per
day/week, etc.
Inhalation, Skin contact, Swallowing,
Eyes, Skin puncture
Is it likely that this will be
exceeded in normal use?
If no, why?
Choose an item.
Choose an item.
Chemical Risk Assessment Form (COSHH) 2016 V3
When choosing your risk controls, consider:
1. Can you eliminate the use of the harmful product and use a safer one
2. Use a safer form of the product, e.g. paste rather than powder
3. Change the process or working methods to emit less of the substance or prevent contact with it
4. Enclose the process so that the product does not escape or extract the emissions at source
5. Have as few people exposed as possible
6. Provide personal protective equipment (last resort)
Risk Controls
No
How could activity result in contact
1
2
3
4
5
6
7
8
Who will be responsible for implementing risk
controls:
Annual review (date of):
Risk controls required to prevent contact
Risk Rating
Chemical Risk Assessment Form (COSHH) 2016 V3
Increasing Consequence
Risk Rating:
5
4
3
Guide to using the risk rating table:
10
8
6
15
12
9
20
16
12
25
20
15
2
4
6
8
10
1
2
3
4
5
Increasing Likelihood
17-25 Unacceptable – Stop activity and
make immediate improvements/seek
further advice
Consequences
Likelihood
1 Insignificant – no
illness
2 Minor – minor illness
5-9 Adequate – Look to improve at
next review
3 Moderate – up to
three days absence
4 Major – more than
three days absence
1 Very unlikely – 1 in a million
chance of it happening
2 Unlikely – 1 in 100,000 chance of it
happening
3 Fairly likely – 1 in 10,000 chance of
it happening
4 Likely – 1 in 1,000 chance of it
happening
1-4 Acceptable - No further action, but
ensure controls are maintained
5 Catastrophic – death
or disabling
5 Very likely – 1 in 100 chance of it
happening
10-16 Tolerable – look to improve
within specified timescale
Chemical Risk Assessment Form (COSHH) 2016 V3
This information should be made available to anyone who uses the chemical / product.
Chemical Safety User Information Sheet
Chemical / Product name
Specific training required before
use?
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Appearance &
odour
Is a written safe working procedure
required?
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What training is needed?
Storage requirements
Method of disposal
Spillage procedure
Personal Protective Equipment (type and EN specification where applicable)
Hands
Eyes
Contact
Effects
IF SWALLOWED
IF INHALED
SKIN CONTACT
EYE CONTACT
NEEDLESTICK / SKIN PUNCTURE
Respiratory Protection
First Aid
Clothing / footwear